Fetal Heart Rate Patterns Research Articles

Maternal Oxygen Administration during Labor: A Controversial Practice.

Oxygen administration to the mother is commonly performed during labor, especially in the case of a non-reassuring fetal heart rate, aiming to increase oxygen diffusion through the placenta to fetal tissues. The benefits and potential risks are controversial, especially when the mother is not hypoxemic. Its impact on placental gas exchange and the fetal acid-base equilibrium is not fully understood and it probably affects the sensible placental oxygen equilibrium causing a time-dependent vasoconstriction of umbilical and placental vessels. Hyperoxia might also cause the generation of radical oxygen species, raising concerns for the developing fetal cells. Moreover, this practice affects the maternal cardiovascular system, causing alterations of the cardiac index, heart rate and vascular resistance, and unclear effects on uterine blood flow. In conclusion, there is no evidence that maternal oxygen administration can provide any benefit in the case of a non-reassuring fetal heart rate pattern, while possible collateral effects warn of its utilization. Oxygen administration during labor should be reserved for cases of maternal hypoxia.

An Update of Our Understanding of Fetal Heart Rate Patterns in Health and Disease

UNDERSTANDING FETAL HEART RATE PATTERNS THAT MAY PREDICT ANTENATAL AND INTRAPARTUM NEURAL INJURY: Christopher A. Lear, Jenny A. Westgate, Austin Ugwumadu, Jan G. Nijhuis, Peter R. Stone, Antoniya Georgieva, Tomoaki Ikeda, Guido Wassink , Laura Bennet , Alistair J. Gunn Seminars in Pediatric Neurology Volume 28, December 2018, Pages 3-16 Electronic fetal heart rate (FHR) monitoring is widely used to assess fetal well-being throughout pregnancy and labor. Both antenatal and intrapartum FHR monitoring are associated with a high negative predictive value and a very poor positive predictive value. This in part reflects the physiological resilience of the healthy fetus and the remarkable effectiveness of fetal adaptations to even severe challenges. In this way, the majority of "abnormal" FHR patterns in fact reflect a fetus' appropriate adaptive responses to adverse in utero conditions. Understanding the physiology of these adaptations, how they are reflected in the FHR trace and in what conditions they can fail is therefore critical to appreciating both the potential uses and limitations of electronic FHR monitoring.

Risk of Cesarean Delivery after Vaginal Inserts with Prostaglandin Analogs and Single-Balloon Catheter Used for Cervical Ripening and Induction of Labor.

(1) Background: Induction of labor is currently the most frequently performed procedure in modern obstetrics, referring to more than one in five women, and it is postulated that the percentage of labor induction will increase. (2) Methods: In total, 2935 patients in uncomplicated full-term pregnancy fulfilled the study inclusion criteria and underwent induction of labor. Pregnant women were divided into three groups: IOL with Dinoprostone, Misoprostol vaginal suppositories, and Foley catheter. Outcomes, including cesarean section rates, time to delivery, and cesarean section indications, were analyzed. (3) Results: There was statistically significantly more cesarean sections within 24 h in the Misoprostol group in comparison with the Dinoprostone and Foley catheter groups (p < 0.0001). The percentage of patients who had a cesarean section due to clinically diagnosed threatened fetal asphyxia was 63% in the Dinoprostone group, 81.3% in the Misoprostol group, and 55.3% in the Foley catheter group. There were statistically significantly more cesarean deliveries due to nonreassuring fetal heart rate patterns within 24 h in the Misoprostol group in comparison with the Dinoprostone and Foley catheter groups (p = 0.0031 and p = 0.0363). (4) Conclusions: Misoprostol may cause a more turbulent and violent course of labor, with a higher rate of increased incidence of nonreassuring fetal heart rate patterns and cesarean deliveries. The use of a Dinoprostone vaginal insert or Foley catheter may provide longer labor, although still within 48 h, with a lower risk of cesarean section caused by nonreassuring fetal heart rate patterns.

Evaluation of fetal acidemia during delivery using the conventional 5-tier classification and Rainbow systems.

The association between prepartum time-series fetal heart rate pattern changes and cord blood gas data at delivery was examined using the conventional 5-tier classification and the Rainbow system for 229 female patients who delivered vaginally. They were classified into three groups based on the results of umbilical cord blood gas analysis at delivery. The fetal heart rate pattern classifications were based on analysis of measurement taken at 10-min intervals, beginning at 120 min pre-delivery. The relationship between fetal heart rate pattern classification and cord blood pH at delivery changed over time. The 5-tier classification at each interval increased before delivery in the Mild and Severe groups compared with the Normal group. No significant differences were observed between acidemia groups. The Rainbow classification showed a significant differences between the acidemia groups at each interval, particularly during the prepartum period. A relationship between classification and outcome was evident before delivery for both the 5-tier classification and Rainbow system.

Decision-to-delivery interval and neonatal outcomes in intrapartum umbilical cord prolapse

BackgroundRapid delivery is important in cases of umbilical cord prolapse to prevent hypoxic injury to the fetus/neonate. However, the optimal decision-to-delivery interval remains controversial.ObjectiveThe aim of the study was to investigate the association between the decision-to-delivery interval in women with umbilical cord prolapse, stratified by fetal heart rate pattern at diagnosis, and neonatal outcome.Study designThe database of a tertiary medical center was retrospectively searched for all cases of intrapartum cord prolapse between 2008 and 2021. The cohort was divided into three groups according to findings on the fetal heart tracing at diagnosis: 1) bradycardia; 2) decelerations without bradycardia; and 3) reassuring heart rate. The primary outcome measure was fetal acidosis. The correlation between cord blood indices and decision-to-delivery interval was analyzed using Spearman’s rank correlation coefficient.ResultsOf the total 103,917 deliveries performed during the study period, 130 (0.13%) were complicated by intrapartum umbilical cord prolapse. Division by fetal heart tracing yielded 22 women (16.92%) in group 1, 41 (31.53%) in group 2, and 67 (51.53%) in group 3. The median decision-to-delivery interval was 11.0 min (IQR 9.0–15.0); the interval was more than 20 min in 4 cases. The median cord arterial blood pH was 7.28 (IQR 7.24–7.32); pH was less than 7.2 in 4 neonates. There was no correlation of cord arterial pH with decision-to-delivery interval (Spearman’s Ρ = − 0.113; Ρ = 0.368) or with fetal heart rate pattern (Spearman’s Ρ = .425; Ρ = .079, Ρ = − .205; Ρ = .336, Ρ = − .324; Ρ = .122 for groups 1–3, respectively).ConclusionIntrapartum umbilical cord prolapse is a relatively rare obstetric emergency with an overall favorable neonatal outcome if managed in a timely manner, regardless of the immediately preceding fetal heart rate. In a clinical setting which includes a high obstetric volume and a rapid, protocol-based, response, there is apparently no significant correlation between decision-to-delivery interval and cord arterial cord pH.

Maternal mood and anxiety effects on the fetal nonstress test

Previous studies have suggested that acute mood states may influence levels of fetal activity. Because the fetal nonstress test relies on markers of fetal activity to suggest fetal wellbeing, its interpretation may be affected by maternal mood. This study sought to determine if there are differences in nonstress test characteristics between pregnant individuals with and without symptoms of mood disorder. In this prospective cohort study, we recruited pregnant individuals undergoing nonstress test in the third trimester and compared the results of the nonstress test between pregnant individuals with scores above and below the cutoff values on validated screening questionnaires for depression and anxiety symptoms, the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder 7-item scale (GAD-7). Demographic information was collected from each participant at the time of recruitment, and medical information was extracted from the electronic medical record. A total of 68 pregnant individuals were enrolled, 10 (15%) of which screened positive for perinatal mood disorders. There was no significant difference in means of time to reactivity (15.6 [4.8] minutes vs 15.0 [8.0] minutes, P=.77), number of accelerations (0.16/min [0.08] vs 0.16/min [0.10], P>.95), number of fetal movements (17.0 [14.7] vs 19.7 [20.4], P=.62), heart rate baseline (138.0 [7.5] bpm vs 139.2 [9.0] bpm, P=.67) or variability (8.5 [2.5] bpm vs 9.1 (4.3) bpm, P=.51) between pregnant individuals who screen positive for mood disorders and those who did not. Fetal heart rate patterns are similar in pregnant individuals with and without symptoms of mood disorder. The results provide reassurance that acute symptoms of anxiety and depression do not have significant effects on the fetal nonstress test.

The prevalence and associated factors of success of labor induction in Hargeisa maternity hospitals, Hargeisa Somaliland 2022: a hospital-based cross-sectional study

BackgroundThe induction of labor is an artificial initiation of labor and has become one of the most common interventions in modern obstetrics to improve maternal and neonatal health. Understanding the prevalence and pregnancy outcomes following labor inductions is crucial in regions with high rates of maternal mortality and morbidity because of insufficient access to comprehensive emergency obstetric care. Therefore, this study aimed to assess the prevalence and associated factors of the success of induction of labor in Hargeisa maternity hospital Somaliland.MethodsA hospital-based cross-sectional study was employed among 453 women in Hargeisa maternity hospitals, Somaliland from January 1st to March 30th, 2022. Data were entered using Epi data version 4.6 and analyzed by using SPSS version 25. Bivariable and multivariable logistic regression were used to identify the associated factors with the success of labor induction and an odds ratio with a 95% confidence interval was used to measure the strength of the association. A P-value of ≤ 0.05 was considered statistically significant in multivariate analysis.ResultsOf a total of 453 study participants who had undergone induction of labor, 349 (77%) of them had successful induction of labor with a 95% CI: 73%, 81%. Favorable Bishop score (AOR = 3.45, 95% CI: 1.98, 5.99), time from the start of induction to delivery < 12 h (AOR = 4.01, 95% CI: 2.16, 7.450), non-reassuring fetal heart rate pattern (AOR = 0.42, 95% CI: 0.22, 0.78) and amniotic fluid change to meconium (AOR = 0.43, 95% CI: 0.23, 0.79) were significantly associated with the success of labor induction.ConclusionThis study implies that three out of four women who underwent induction had successful induction of labor. Favorable bishop score, time from the start of induction to delivery < 12 h, non-reassuring fetal heart rate pattern, and amniotic fluid change to meconium were significantly associated with the success of labor induction. The hospital should establish a clear bishop scoring system and there should be a strict follow-up on the condition of the fetal heartbeat and take corrective actions as needed. The factors related to healthcare facilities and providers need to be addressed by additional prospective studies.

Fetal Middle Cerebral Artery and Umbilical Artery Pulsatility Index Doppler Associations With Pregnancy Risk and Neonatal Outcomes

OBJECTIVE:To evaluate the role of the middle cerebral artery (MCA) to the umbilical artery (UA) blood velocity waveform’s pulsatility index (PI) screening in proximity to delivery as a predictor of high-risk pregnancy and neonatal outcomes.METHODS:The study used a nested case–control method, consisting of 34 women with high-risk pregnancies and 34 pregnant women who were classified as normal. The MCA/UA PI ratio was evaluated within 14 days before delivery. All subjects’ newborns were evaluated for neonatal outcomes, which included fetal distress, abnormal cardiotocography or fetal heart rate patterns, neonatal mortality, Apgar score, duration of hospitalization, and neonatal intensive care unit (NICU) admission. A cutoff point for MCA/UA PI ratio was assessed using the receiver operating characteristic curve. The correlations between the MCA/UA PI ratio and high-risk pregnancy and neonatal outcomes were assessed with multivariable linear regression based on the cutoff point obtained.RESULTS:The MCA/UA PI ratio in high-risk pregnancy was significantly lower compared with normal pregnancy (p= .011). The MCA/UA PI ratio of ≤1.32 finding was 6.37 times higher in high-risk pregnancy (p= .017, AOR 6.37, 95% CI 1.40–28.97), 5.9 times higher in pregnancy with the neonate’s first-minute Apgar less than 7 (p= .031, AOR 5.90, 95% CI 1.18–29.61), and 18.62 times higher in neonates admitted to the NICU (p= .023, AOR 18.62, 95% CI 1.43–2702.94).CONCLUSIONS:Low MCA/UA PI is associated with high-risk pregnancies and adverse neonatal outcomes, such as low first-minute Apgar score and NICU treatment.

Effect of the Presence of Nuchal Cords on Vaginal Breech Labor.

Breech delivery has been reported to be associated with a high incidence of abnormal fetal heart rate pattern leading to neonatal asphyxia. In this study, we examined the effect of the presence of nuchal cords on perinatal outcomes of vaginal breech labor. We reviewed the obstetric records of all singleton breech labor cases at the Japanese Red Cross Katsushika Maternity Hospital between 1999 and 2011. Of the 266 breech labor cases in singleton pregnancies, the presence of nuchal cords was recognized in 50 cases (18.8%) on neonatal findings at birth. We compared the clinical characteristics and perinatal outcomes between the breech labor cases with and without nuchal cords. A chi-square test was used for categorical data, and a p-value <0.05 was considered significant. It was found that the incidence of fetal heart rate abnormality during breech labor or neonatal asphyxia in the deliveries with nuchal cords was not significantly different from that in those without nuchal cords. Also,there was no significant difference in the rate of emergent caesarean delivery between the two labors with and without nuchal cords. The current results suggest that the presence of nuchal cords may not be associated withperinatal outcomes. Our results may become one of several pieces of evidence leading to the alleviation of anxiety in pregnant women with breech presentation and fetal nuchal cords.

Fetal heart rate patterns and the incidence of adverse events after oral misoprostol administration for cervical ripening among low-risk pregnancies

Objective Though misoprostol is commonly used for inpatient cervical ripening, its use in outpatient settings has been limited by safety concerns. This study was conducted to assess the association between early fetal heart tracing (FHT) and maternal tocodynamometry patterns and the incidence of adverse fetal and pregnancy outcomes after the administration of oral misoprostol for cervical ripening. Methods We conducted a retrospective cohort study of 9908 low-risk patients at ≥37 weeks gestation who received oral misoprostol for cervical ripening prior to rupture of membranes between 01/01/2012 and 12/31/2017 at Kaiser Permanente Northern California hospitals as inpatients. We excluded patients who received a different agent for cervical ripening or had any need for additional inpatient monitoring, including hypertensive disorders of pregnancy, diabetes, or intrauterine growth restriction. Abnormal FHT, abnormal uterine activity, and adverse pregnancy or fetal-related events documented in the electronic health record in the four hours after administration of the first and second doses of misoprostol were assessed using descriptive statistics. Results We found that 0.9% of patients experienced tachysystole after the first dose of misoprostol (0.6% without decelerations; 0.3% with decelerations). The incidence of variable decelerations only and other FHT abnormalities (i.e. bradycardia, late or prolonged decelerations, or absent or minimal variability) in the first hour after misoprostol administration were 7.1% and 6.7% respectively, and diminished over time. The need for tocolytic use was 0.2% in the first hour and declined over time to 0.03% in the fourth hour after the first dose. Urgent cesarean delivery occurred in 0.1% of patients after receiving the first dose of misoprostol. Patients who did not experience variable, prolonged, or late decelerations in the first hour after the initial misoprostol dose were less likely to have such FHT abnormalities in the subsequent three hours compared to patients who had other FHT abnormalities (11.8% among patients with no FHT abnormalities vs. 43.7% among patients with other FHT abnormalities; p <.001). The overall trends in outcomes over time were similar after the second dose of misoprostol. Conclusion The risk of short-term adverse outcomes associated with misoprostol is low among relatively low-risk patients. FHT abnormalities occurred in up to 32% of patients in the first four hours of monitoring post-misoprostol. Patients with no FHT abnormalities in the first hour after receiving misoprostol had a low risk of developing adverse outcomes and FHT abnormalities on continued monitoring, while patients with any type of deceleration in the first hour were at higher risk of adverse outcomes and FHT abnormalities. Our data may inform the development of protocols for cervical ripening that allow reduced monitoring for a subset of low-risk patients, however, more research is needed to validate findings and develop clinical protocols.

Meconium Stained Amniotic Fluid and Associated Factors among Women Who Gave Birth at Term in Adama Hospital Medical College, Ethiopia.

Meconium stained amniotic fluid (MSAF) is a commonly observed phenomenon in day-to-day practice of obstetrics. The reported prevalence of MSAF was 7-22% of all term deliveries. Some of the factors that increases the risk of meconium stained amniotic fluid includes; advanced gestational age at delivery, prolonged rupture of membranes, intra-amniotic infection, pre-eclampsia, oligohydroamnios, and diabetes mellitus. The study aimed to determine the prevalence of meconium stained amniotic fluid and its associated factors among women who gave birth at term, from January 1st to July 30th, 2020, at Adama Hospital Medical College. Institutional based cross-sectional study was conducted on 314 laboring women who gave birth at term. Systematic random sampling was used to select the study participants. Data entry and analysis were made by using Epi- info 7 and SPSS version 20, respectively. The prevalence of meconium stained amniotic fluid was 23.9%. Late term pregnancy, Oligohydraminos, Antepartum hemorrhage, Premature rupture of membrane, and Non-reassuring fetal heart rate pattern were significantly associated with meconium-stained amniotic fluid. The prevalence of MSAF was comparable with other studies. Late-term pregnancy, oligohydramnios, antepartum hemorrhage, non-reassuring fetal heart rate pattern, and premature rupture of the membrane were factors associated with an increased risk of MSAF.

Ambulatory antenatal fetal electrocardiography in high-risk pregnancies (AMBER): protocol for a pilot prospective cohort study

IntroductionFetal heart rate (FHR) monitoring is a vital aspect of fetal well-being assessment, and the current method of computerised cardiotocography (cCTG) is limited to the hospital setting. Non-invasive fetal ECG...

Does maternal oxygen administration during non-reassuring fetal status affect the umbilical artery gas measures and neonatal outcomes?

To clarify whether maternal oxygen administration during vaginal delivery improves umbilical artery (UA) gas measurements and neonatal outcomes. Singleton pregnancies requiring operative vaginal delivery or emergency cesarean section (CS) due to non-reassuring fetal status (NRFS) during vaginal delivery at our hospital from 2018 to 2021 were retrospectively investigated. Intrapartum fetal wellbeing was evaluated based on the 5-tier fetal heart rate (FHR) pattern which is a delivery management method widely used in Japan. Operative vaginal deliveries or emergency CS was performed under integrated judgment in NRFS. Patients were divided into the oxygen group to whom oxygen (10 L/min) was supplied by a facemask and the room air group. The UAgas measurements and neonatal outcomes were compared. The oxygen administration was classified by conditions before and after the coronavirus disease 2019 pandemic. As a secondary evaluation, stratification of FHR pattern levels and factors associated with UA pH < 7.15 were examined. A total of 250 patients required obstetric surgical delivery due to NRFS, including 140 (56%) and 110 (44%) in the oxygen and room air groups, respectively. No differences in maternal background factors were found between both groups, except for maternal age. UA gas measurements and neonatal outcomes also showed no significant differences. No significant factors were extracted in the multivariate analysis for UA pH < 7.15. Trans-maternal oxygen administration for intrapartum NRFS did not affect neonatal cord blood gasses or neonatal outcomes. Thus, routine oxygen administration for intrapartum NRFS may not always be necessary.

Maternal heart rate variability patterns associated with maternal hypotension and non-reassuring fetal heart rate patterns following initiation of combined spinal-epidural labor analgesia: a prospective observational trial

BackgroundWe evaluated whether baseline maternal heart rate variability (HRV), including the Analgesia Nociception Index (ANI), is associated with maternal hypotension and fetal heart rate (FHR) abnormalities following combined spinal-epidural (CSE) labor analgesia. MethodsLaboring women were enrolled in this prospective observational study. The primary endpoint was maternal hypotension. The secondary endpoint was FHR abnormalities within 30 min following CSE analgesia initiated with intrathecal plain bupivacaine 1.0 mg and fentanyl 20 µg. The maternal ANI, electrocardiogram, blood pressure, heart rate, oxygen saturation, and FHR tracings were recorded 15 min before and 30 min after CSE. Parturients were grouped based on presence of hypotension and FHR abnormalities. Patient demographics and HRV metrics were compared. Receiver operating characteristics (ROC) curves were constructed for the prediction of hypotension and FHR abnormalities. ResultsNo significant intergroup differences were detected in patient characteristics. Several baseline HRV metrics and ANI differed significantly between the normotensive (n = 50) and hypotensive (n = 31) groups and between parturients showing FHR abnormalities (n = 19) and those showing reassuring FHR traces (n = 62). The area under the ROC curve (AUC) for predicting hypotension of the baseline low-frequency (LF)/high-frequency (HF) ratio was 0.677 (95% CI 0.55 to 0.80), and that of the ANI was 0.858 (95% CI 0.78 to 0.94). For predicting non-reassuring FHR patterns, the AUC of the LF/HF ratio was 0.77 (95% CI 0.65 to 0.89), and that of the ANI was 0.833 (95% CI 0.72 to 0.94). ConclusionsThe ANI can predict the propensity for maternal hypotension and non-reassuring FHR patterns following CSE.

Correlation Between Fetal Heart Rate Evolution Patterns and Magnetic Resonance Imaging Findings in Severe Cerebral Palsy: A Longitudinal Study

ABSTRACT The study of fetal heart rate (FHR) pattern evolution during labor is useful for evaluating the timing of perinatal brain injury that can lead to cerebral palsy (CP). Magnetic resonance imaging (MRI) is also useful for prospectively predicting neurological outcomes and retrospectively evaluating the pathophysiological types and patterns that affect brain injury. Using both FHR evolution studies and MRI findings of infants may help to evaluate the insult severity and pattern, as well as insult timing, of CP. Currently, studies on the association between these 2 tools are lacking. The aim of this study was to investigate the association between FHR patterns and MRI findings. This was a longitudinal cohort study using the nationwide database of the Recurrence Prevention Committee, Japan Obstetric Compensation System for Cerebral Palsy. Included were infants with severe CP at ≥34 weeks of gestation between 2009 and 2014. Severe CP was defined as equivalent to levels 3 to 5 of the Gross Motor Function Classification System. Excluded were infants with missing or uninterpretable cardiotocograph tracings or unavailable brain MRI findings after birth. Cardiotocograph strips were analyzed, and FHR patterns were categorized into 6 groups: bradycardia, persistently nonreassuring (NR-NR) pattern, reassuring-prolonged deceleration (R-PD), initially reassuring that progressed over time to a nonreassuring, or Hon pattern (R-Hon), persistent reassuring (R-R) pattern, and unclassified. Brain MRI patterns were classified based on the predominant site—basal ganglia–thalamus (BGT), white matter, watershed, stroke, normal, and unclassified—then described as mild, moderate, or severe. A total of 672 were included in the analysis. In the analysis of FHR patterns, 9% had bradycardia, 25% had NR-NR, 17% had R-PD, 17% had R-Hon, 13% had R-R, and 20% were unclassified. The majority had BGT injury (76%), indicating the cause as acute, profound hypoxia-ischemia. In infants in which the BGT region was spared, 5.4% had white matter injury, 1.2% had watershed injury, 1.6% had stroke, 1.9% had normal findings, and 14% were unclassified. In infants with BGT injury, common perinatal risk factors for CP included umbilical cord abnormality (&gt;40%), placental abruption (23%), intrauterine infection (18%), and small for gestational age (13%). There was a significant increased risk of BGT injury in infants with placental abruption (adjusted odds ratio [aOR], 8.02; 95% confidence interval [CI], 1.53–41.95), but a decreased risk in small for gestational age infants (aOR, 0.38; 95% CI, 0.17–0.86). Basal ganglia–thalamus injury impacted a substantial proportion of infants across all FHR patterns, including bradycardia (97%), NR-NR (75%), R-PD (90%), R-Hon (76%), R-R (45%), and unclassified cases (45%). Most infants with BGT injury showed severe damage, with significant differences observed in the bradycardia group (aOR, 6.71; 95% CI, 1.26–35.75), NR-NR group (aOR, 2.51; 95% CI, 1.10–5.73), and R-PD group (aOR, 7.04; 95% CI, 2.24–22.10) compared with the R-R group after adjusting for clinical background. Cortical damage in the BGT accompanied most cases—with significantly more severe involvement in the bradycardia group (aOR, 5.61; 95% CI, 1.20–26.33), NR-NR group (aOR, 4.57; 95% CI, 1.33–15.68), and R-Hon group (aOR, 4.69; 95% CI, 1.22–18.00). Brainstem injuries were less frequent, with no difference in prevalence between groups. In summary, 76% of infants with severe CP developed BGT injury based on the analysis of brain MRI findings. Basal ganglia–thalamus injuries were more frequently characterized by severe neonatal asphyxia versus non-BGT injuries.

What is the Meaning of Fetal Heart Rate Patterns according to Physiopathology?

The analysis and interpretation of the Fetal Heart Rate in the parturition watch have shown their limits in the identification of the fetuses risking neonatal asphyxia, which consequences are death or Cerebral Palsy. The weak specificity of the continuous electronic heart rate monitoring generates an unjustified C-section excess, associated to an increasing of the immediate and ulterior materno-fetal morbi-mortality. Presently, the visual analysis of the Fetal Heart Rate exclusively lays on chronomorphological patterns. However, there is another way that calls on the knowledge of the physiological processes of the fetus’ cardiovascular control: In situation of normoxemia, the peripheral baroreceptors of the near term fetus is responsible for the control of the arterial pressure with both systems in action: the permanent accelerating sympathetic system and the intermittent braking parasympathetic system, which causes short-term variability. In situation of acute hypoxemia, the peripheral chemoreceptors are stimulated and induce a rapid vagal mediated fall in heart rate (i.e. deceleration), and a peripheral vasoconstriction mediated by sympathetic nervous system. In situation of acidosis, the central chemoreceptor is activated. It then stimulates the sympathetic system generating a fetal tachycardia, and inhibits the functioning of the peripheral baroreceptors, producing minimal to absent variability. From that comes out that the variability and the heart baseline are the only two patterns that reflect the fetal prognosis.

Effect of maternal cortisol levels on fetal heart rate patterns in primiparous pregnant women in the third trimester

This study aimed to determine whether maternal cortisol levels affect fetal heart rate patterns in primiparous pregnant women in the third trimester. This cross-sectional descriptive study included 400 primiparous pregnant women with uncomplicated pregnancies between November and December 2022. The study included primiparous pregnant women over 18 years old in the third trimester who had not exercised for at least 2 h before the fetal heart rate monitoring and had a healthy pregnancy without consuming any food or drink. Fetuses with decelerating heartbeats and pregnant women who showed uterine contraction and cervical dilation during the fetal heart rate monitoring were excluded from the study. Research data were collected with the data collection form. The fetal heart rate data were collected using a cardiotocograph. At least two accelerations during the 20-min nonstress test period were the basis for diagnosing a reactive nonstress test. About 5 mL of maternal saliva for cortisol measurements was collected before fetal heart rate monitoring. Research data were analyzed with IBM SPSS Statistics for Macintosh, Version 28.0. A p-value of <0.05 was considered significant. There were no significant differences in the comparison of the groups in terms of education and income status, family type, fetal gender, pregnancy planning status, BMI and age averages, or gestational week averages (p>0.05). The number of at least two accelerations required for the diagnosis of reactive NST was also higher in Group 1 (maternal salivary cortisol level ≤24.20). A moderately positive relationship between fetal heart rate and maternal salivary cortisol was observed (r=0.448, p=0.000). In total, 11.9% of the total change in fetal heart rate level is explained by maternal cortisol (R2=0.119). Maternal cortisol increases fetal heart rate level (ß=0.349). These findings suggest that stress in primiparous pregnant women with high cortisol levels may influence fetal heart rate patterns. It was revealed that the increase in cortisol level, considered a stress hormone, may be a harbinger of fetal tachycardia.

Effects of magnesium sulfate on the heart rate of preterm fetal sheep with intraamniotic inflammation

The specific findings of fetal heart rate (FHR) patterns after drug administrations under intraamniotic inflammation have not been clarified. This study aimed to investigate the effects of fetal magnesium sulfate (MS) injection on the heart rate of preterm fetal sheep with intraamniotic inflammation during increasing and decreasing levels of serum MS concentration.

Intrapartum Electronic Fetal Monitoring and Perinatal Outcomes

Aim: The aim of this study was to assess the components of cardiotocography (CTG) during labor to identify the variables associated with the risk of adverse perinatal outcomes and to ascertain the mode of delivery in these women. Materials and Methods: This prospective observational study included 191 women at term with singleton pregnancy in labor. The CTG findings including baseline heart rate, accelerations, beat-to-beat variability, and type and severity of decelerations were noted as per the International Federation of Gynecology and Obstetrics classification and grouped into Category II or III patterns as per the National Institute of Child Health and Human Development classification. Low APGAR score, cord PH &lt;7, neonatal intensive care unit admission, respiratory distress, and hypoxic-ischemic encephalopathy were considered adverse neonatal outcomes. Results: Persistent fetal tachycardia, poor beat-to-beat variability, and severe variable deceleration showed a significant association with adverse neonatal outcome and delivery by cesarean section (P &lt; 0.05). Adverse neonatal outcomes were noted in 4.2% of babies and 40.9% of babies born to mothers whose CTG was categorized as II and III patterns, respectively (P &lt; 0.001). Birth by cesarean section was significantly different between those with Category II and Category III patterns, 33.7% and 65.4%, respectively (P &lt; 0.01). Conclusion: Reduction in the beat-to-beat variability and presence of severe variable decelerations are independent risks for adverse neonatal outcomes, irrespective of the category of CTG pattern. Category III fetal heart rate pattern shows a significant association with adverse outcomes and risk of cesarean delivery. Grading the Category II patterns may help in identifying variables that are truly associated with acidemia and further research into this is recommended.

Adverse Maternal and Perinatal Outcomes of Meconium-Stained Amniotic Fluid in Term Labor at Hospitals in South Gondar Zone, Northwest Ethiopia: A Prospective Cohort Study.

The passage of meconium during labor increased the chance of undesirable birth outcomes. The adverse effects of meconium are worsening in resource-limited countries. In Ethiopia, there is an argument concerning meconium's negative effects and management on pregnant women and their babies. Therefore, this study was intended to assess the adverse maternal and perinatal outcomes of meconium in term labor in the South Gondar Zone, Ethiopia. A prospective cohort study was conducted using 580 laboring mothers (145 exposed and 435 nonexposed groups). A two-stage sampling method was implemented to get study subjects. The data were collected using an interviewer-administered structured questionnaire and a medical chart review. SPSS version 25 was used for data analysis. Chi-squared and Fisher's exact tests were used to compare the two groups' differences. The strength of the association was measured using relative risk with a 95% CI. There was more operative delivery (28.3% versus 5.3%), puerperal sepsis (79.54% versus 2.06%), nonreassuring fetal heart rate pattern (29.7% versus 2.1%), meconium aspiration syndrome (7.58% versus 0.68%), neonatal sepsis (9% versus 4.1%), perinatal asphyxia (13.8% versus 7.6%), admission to the neonatal intensive care unit (23.4% versus 3.2%), and early neonatal deaths (4.8% versus 1.4%) among meconium stained groups as compared to the clear amniotic fluid groups. Meconium-stained amniotic fluid significantly increased adverse maternal and perinatal outcomes in Ethiopia. The risk of perinatal asphyxia, nonreassuring fetal heart rate pattern, neonatal sepsis, meconium aspiration syndrome, admission to the NICU, early neonatal death, operative delivery, and puerperal sepsis were significantly higher in meconium-exposed groups. Special attention should be given to meconium-exposed mothers during the intrapartum period and in postnatal follow-up.